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from Clinical/Therapeutic Issues
Same-Gender Attraction:
Clinical Observations From a Self Psychology Perspective
Ben Z. Sorotzkin, Psy.D.
Brooklyn, NY
bensort@aol.com
I was very pleased to read Dr. Nicolosi's discussion on "grief work" in the
April 2001 issue of the NARTH Bulletin. I have long felt that
psychotherapy based on Self-Psychology principles (1) would add a
significant and necessary depth to Reparative Therapy for same-gender
attraction. Reparative Therapy emphasizes that a male has to feel
comfortable and secure in his masculine role before he can venture into the
world of females. Self -Psychology emphasizes that developing a stable and
positive sense of self is a necessary precursor to developing a gender
identity.
I would like to share some clinical insights gleaned from
Self-Psychological psychotherapy with patients struggling with same-gender
attraction. These observations highlight the importance of understanding
the specific psychological meaning of symptoms and the necessity of
resolving problems regarding the patient's sense of self before attending
to gender identity issues.
"David"
David [names and details have been changed to preserve confidentiality] was
a 26-year-old single, religious male struggling with same-gender
attraction. David's family fit both the classic "triadic family" model,
with a critical, rejecting father and an over-involved mother, and the
"expanded triadic narcissistic model" described by Dr. Nicolosi. David was
expected to mold himself in a matter that met his parent's unmet emotional
needs rather than have his parents adjust themselves to meet his unique
developmental needs (2, 3).
During one session David expressed amazement that his friend "Samuel" had
to struggle not to lust after pretty women. The cause for David's
amazement wasn't that someone could lust after women. Rather it was the
fact that Samuel was not particularly good looking. "What makes him think
that a pretty women would ever agree to have a physical relationship with
him!?" he wondered. This amazement reflected the superficial nature of the
attitudes and relationships in David's family. There was little emotional
depth nor an appreciation of the multifaceted nature of human motivations,
needs and emotions. In such an atmosphere, the idea that someone might
very well like you for internal, non-obvious reasons, such as personality,
character, sense of humor etc. seemed impossible. (David's mother once
reacted to my suggestion that her daughter sounded depressed by showing me
a picture of her daughter. "How can she be depressed, she's beautiful!?")
Likewise, growing up in a very critical family makes it very difficult to
imagine that someone would overlook minor flaws because of their
appreciation of other qualities.
Not surprisingly, David's ideas regarding attraction to others were also
totally superficial. In spite of being intelligent, knowledgeable and
articulate, years of criticism and rejection by his father made it
difficult for him to believe that anyone would be interested in him for
anything other than his body. (As a result he became extremely anxious
over the earliest signs of thinning hair.)
David couldn't lust after females - not because he inherently wasn't
capable of desiring females. Rather, it was because he couldn't imagine
them desiring him. The source of this belief wasn't, at its root, gender
related. In fact, as a result of his father's lack of interest in him (as
a separate individual) it was difficult for him to believe that anyone
would be interested in him. However, since he had some same-gender sexual
experiences in high school, he could imagine males being interested in him.
Another interesting feature in David's same-gender attraction was the
underlying motivation for his sexual interest in males. What "turned him
on" was the fact that he could get them to desire him, rather than his
desire for them. (The sexual component was necessary because he needed
concrete evidence of their interest in him.) For someone who never felt
cared for by his parents, being desired for any reason could be quite a
powerful experience.
A related feature of his attraction was that he was primarily interested in
males whom he perceived to be (based on their external appearance) very
religiously devout. The subconscious reasoning went as follows: This
person obviously has no sexual desires (!). If he, none-the-less, is
willing to have a sexual relationship with me, it must be that he really
cares about me. The fact that, in David's imagination, someone was more
concerned with his (David's) needs than his own, was in sharp contrast with
his experience with his parents.
At times David found himself attracted to low status, disheveled looking
males. This surprised him, especially since he was so focused on external
appearances. Further exploration revealed that when David was feeling
particularly unlovable, he would be convinced that a high status,
good-looking person would never take an interest in him. He would then
have to settle for an object of interest that he considered a "safe bet."
The primary purpose of David's sexual acting out was to feel wanted by
someone - a feeling he was sorely lacking. The enhancing of his masculine
identity was secondary.
"Joseph"
Joseph was a 16-year-old student in an all-male religious high school. It
was later revealed that, at 9 years of age, an older male had sexually
molested him. Since then he has had ongoing sexual contact with a number
of males. At first, it was always with peers, but then he molested a boy 4
years younger than himself. He was discovered and referred for
psychotherapy. Joseph related that by the age of 11 he realized that there
was something wrong with his sexual acting out. When I inquired why he
didn't ask his parents for help, he exclaimed, "I would rather have killed
myself!"
I explored with Joseph the reason for this reaction. We eliminated the
usual culprits. He wasn't afraid that they would react punitively or that
they wouldn't be supportive. Rather, since 7th grade he had become a star
pupil and a source of tremendous pride for his parents. In fact, his
father described him as having been the "apple of our community's eye." He
was seen as the model that the children of their tight-knit religious
community were encouraged to emulate. Joseph couldn't tolerate the thought
of disappointing his parents.
In his younger years, Joseph was a mediocre student while his two older
brothers were highly accomplished in their academic studies and in their
level of religious observance. In retrospect it became clear that his
parents required the success of their children in order to counteract their
own feelings of inadequacy. It became Joseph's subconscious goal to also
bring pride to his parents. His motivation for academic success was not
the healthy internal drive for accomplishments and growth. Rather, it was
the need to satisfy his parent's unmet emotional needs. This led to the
"quest for perfection" where any evidence of imperfection has to be
disavowed (4, 5). Since his sense of self depended on bringing pride to
his parents the thought of losing this status provoked thoughts of suicide.
Least someone think that this scenario is far fetched, let me share with
you a conversation I had with Joseph's father many months into the
treatment. I commented that it would have been helpful if Joseph had felt
comfortable enough to confide in his parents regarding his sexual acting
out. "That would have been reflective of a lack of honor for one's parents
to cause them such aggravation," he protested. He totally rejected my
suggestion that giving parents the opportunity to help you solve your
difficulties is more honorable to them in the long run. Is it any wonder
then, why Joseph felt that suicide was preferable to causing aggravation to
his parents? If he hadn't been discovered, Joseph's need to serve as a
"selfobject" (6) for his parents would have prevented him from seeking help
and thus he would have most likely become actively homosexual as an
adult.
Conclusion
These two brief vignettes underscore the importance of attending to
deficits in the sense of self, in addition to the deficit in gender
identity, when helping patients who suffer from same-gender attraction.
Despite the objection of some therapists to what they term "self-pity," it
is insufficient to merely exhort patients to "move forward" and "don't
dwell on the past." It is imperative that they work through the rage and
grief resulting from existing for the purpose of gratifying their parents'
narcissistic needs rather than their own developmental needs.
I agree with Dr. Nicolosi that many therapists avoid dealing with these
issues because it requires exposing ourselves to intense feelings of
primitive rage and grief. While this can often be more emotionally
draining than we can tolerate, the rewards of working through these
feelings are great, both for the patient and the therapist.
References
- E.g., Stolorow, R.D., Brandchaft, B., & Atwood, G.E. (1987), Psychoanalytic Treatment: An Intersubjective Approach. Hillsdale, NJ: The Analytic Press.
- Broucek, F. (1991). Shame and the Self. New York: Guilford.
- Miller, S. B. (1996). Shame in Context. Hillsdale, NJ: The Analytic Press.
- Sorotzkin, B. (1985). The quest for perfection: Avoiding guilt or avoiding shame? Psychotherapy, 22, 564-571.
- Sorotzkin, B. (1998). Understanding and treating perfectionism in religious adolescents. Psychotherapy, 35, 87-95.
- Kohut, H. (1997). The Analysis of the Self. New York: International Universities Press.
Updated: 3 September 2008
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